Topic Contents

Discusses cardiac rehabilitation (rehab), which helps you feel better and reduce risk of future heart problems with exercise and lifestyle changes. Looks at rehab for people who have had a heart attack, bypass surgery, or heart or blood vessel disease.

Cardiac Rehabilitation

Topic Overview

What is cardiac rehabilitation?

Cardiac
rehabilitation (rehab) teaches you how to be more active and make lifestyle
changes that can lead to a stronger heart and better health. Cardiac rehab can
help you feel better and reduce your risk of future heart problems.

In cardiac rehab, you work with a team of health professionals. Often the
team includes a doctor, a nurse specialist, a dietitian, an exercise therapist,
and a physical therapist. The team designs a program just for you, based on
your health and goals. Then they give you support to help you succeed.

If you have a heart problem or had surgery, you may be afraid to exercise. Or if you
have never exercised, you may not know how to get started. Your cardiac rehab
team will help you start slowly and work up to a level that is good for your
heart.

Many hospitals and rehab centers offer cardiac rehab
programs. You may be part of a cardiac rehab group, but each person will follow
his or her own plan.

Who should take part in cardiac rehab?

Doctors
often prescribe cardiac rehab for people who have had a
heart attack or
bypass surgery. But people with many types of heart or
blood vessel disease can benefit from cardiac rehab. Rehab might help you if
you have:

Often people are not given the chance to try cardiac
rehab. Or they may start a program but drop out. This is especially true of
women and older adults. And that's not good news, because they can get the same
benefits as younger people. If your doctor suggests cardiac rehab, stay with it
so you can get the best results.

Medicare will pay for cardiac
rehab for people with certain heart problems. Many insurance companies also
provide coverage. Check with your insurance company or your hospital to see if
you will be covered.

Exercise is a big part of cardiac rehab. So before you
get started, you will have a full checkup, which may include tests such as an
electrocardiogram (EKG or ECG) and a "stress test"
(exercise electrocardiogram). These tests show how well your heart is working.
They will help your team design an exercise program that is safe for you.

At first your rehab team will keep a close watch on how exercise
affects your heart. As you get stronger, you will learn how to check your own
heart rate when you exercise. By the end of rehab, you will be ready to
continue an exercise program on your own.

What are the benefits of cardiac rehab?

Starting
cardiac rehab after a heart attack can lower your chance of dying from heart disease and can help you stay out of the hospital. It may reduce your need for
medicine.

Cardiac rehab may also help you to:

Have better overall health.

Lose weight or keep weight off.

Feel less depressed and more
hopeful.

Have more energy and feel better about yourself.

Changing old habits is hard. But in cardiac rehab, you
get the support of experts who can help you make new healthy habits. And
meeting other people who are in cardiac rehab can help you know that you're not
alone.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Actionsets are designed to help people take an active role in managing a health condition.

Phases of Cardiac Rehab

Cardiac rehab
is a program designed specifically for you and your medical needs. It includes
exercise, lifestyle changes, education, and emotional support. It can help
improve your health and enable you to live a more active life. Cardiac rehab can also help you return
to work safely and in a timely manner.

You may start a cardiac
rehab program while you are still in the hospital after having treatment for a
heart attack or other heart problem, soon after leaving the hospital, or at any
other time to help prevent future heart problems, improve the quality of your
life, and make you healthier. Your doctor will give you an exercise
prescription that gives you and your cardiac rehab team guidelines for the
frequency, duration, and intensity of exercise. The prescription will be based
on your medical condition and your fitness level.

How fast you
recover depends on your age, your health, and whether you have other health
conditions that may slow your recovery. A younger person without other health
problems may improve more quickly than an older person who is in poor health.
Depending on your condition and how you respond to rehab, you may stay in a
certain phase or move back and forth among the various phases. There is no
set length of time that you must stay in a specific phase.

Cardiac rehab has four phases. Your doctor will determine
which phase is best for you to start your program.

Inpatient program: Phase I

Phase I takes place in
the hospital after you have experienced a heart attack, heart surgery, or other major heart
problem.
Phase I of cardiac rehab usually includes:

Determining how well you can care for
yourself (bathing, dressing, and grooming) after your heart attack or
surgery.

Measuring your ability to
exercise. Your doctor will probably want you to have
an exercise test before you begin your cardiac rehab exercise program. This
test will show what types of exercise are safe for you and how soon you can
begin to exercise.

Identifying which daily activities, such as
lifting, you can safely do.

Providing patient and family
education about the lifestyle changes you need to
make, such as
eating healthy foods and quitting smoking.
Changes in your diet may be difficult to make. But even small changes can help
improve cholesterol levels and improve your health. For ideas that can help you
get started, see:

Doing light exercise, such as walking short
distances several times a day and possibly beginning a
weight-training program.

Outpatient programs: Phase II, Phase III, and Phase IV

The remaining three phases of your cardiac rehab take
place outside the hospital. At first, your rehab team will keep a close watch
on how exercise affects your heart and how you are progressing, before
gradually releasing you from supervision to continue cardiac rehab on your own.
The healthier lifestyle you've learned—including eating a balanced diet,
exercising regularly, and not smoking—can then become a way of life for
you.

During this time you may also see your doctor regularly to
treat other medical conditions, including high cholesterol and high blood
pressure.

Why It Is Done

Cardiac rehab
can help you recover
after being in the hospital for a heart problem or heart surgery. Rehab can help
improve your quality of life if you have long-term heart disease, such as heart failure. Cardiac rehab can also help you prevent
future heart problems if you are at high risk for heart disease or
heart attack.

People of any
age can benefit from a rehab program. But this is especially true for older
adults, women, and people who are at higher risk for heart failure.
Cardiac rehab can also help you return to work safely and in a timely
manner.

You might benefit from cardiac rehab if you have a heart problem or had a procedure or surgery. These include:

Not all people who have had the conditions or procedures listed
above may be appropriate candidates for cardiac rehab. You may have other
medical concerns that prevent your doctor from recommending cardiac rehab.
But almost everyone with heart disease or risk factors for heart disease
would benefit from some form of risk factor assessment, activity counseling,
and health education.

Exams and Tests

Before starting a
cardiac rehabilitation (rehab) program, a thorough risk assessment will
be done to find out your heart health and the types of exercises you can
safely do. Testing may be done before and during cardiac rehab to help your
doctor decide whether you can safely take part in a program and to monitor your
progress.

Tests to find out your ability to exercise that may be
done before you start cardiac rehab include:

Resting electrocardiogram (EKG or ECG), a test that measures the electrical
signals that control the rhythm of your heartbeat. The graph that shows the
results is called an electrocardiogram. A resting ECG will sometimes show if
more extensive testing is needed before you start an exercise
program.

Exercise electrocardiogram (ECG), a
test that records the electrical activity of the heart. An exercise
electrocardiogram (sometimes called a stress or treadmill test) is done during
exercise to evaluate how the heart responds to exercise. Your doctor can use
the test results to prescribe a safe amount of exercise for
you.

Echocardiogram (echo), a type of
ultrasound test that uses high-pitched sound waves to
produce an image of the heart. The sound waves are sent through a device called
a transducer and are reflected off the various structures of the heart. This
test shows how well your heart is pumping blood and how well your heart valves
are working. Sometimes it is combined with an exercise stress
test.

Cardiac perfusion scan, a test to estimate
the amount of blood reaching the heart muscle during rest and exercise. It is
typically done to find out the cause of unexplained chest pain or to find out
the location and amount of injured heart muscle after a
heart attack.

Ambulatory electrocardiogram (Holter monitoring test), which monitors the
electrical activity of your heart while you go about your usual daily
activities. Many heart problems occur only during certain activities, such as
exercise, eating, sex, emotional stress, bowel movements, or even sleeping. A
continuous recording is much more likely to detect any abnormal
heartbeats that occur during these activities.

Other testing can help monitor your progress during cardiac
rehab. Additional monitoring may include blood pressure, cholesterol, weight,
and blood sugar levels.

You will be monitored
closely when you first begin your cardiac rehab program. But after your
exercise program is well established, you probably won't need continuous
supervision. But if your doctor determines that you have special needs, he or
she may want you to wear a monitoring device at home.

Risks

Cardiac rehabilitation exercise programs are safe and helpful. Exercise helps you return to your normal life. But
there is a small risk of complications.1

If you have a health problem that makes exercise unsafe, your rehab will not include an exercise program. These health problems include:

Even if you can't exercise or be active, you will benefit
from other parts of a cardiac rehab program. For example, you can get help with
quitting smoking and reducing stress. And you can get advice on how to eat a
heart-healthy diet. This type of education can lower the risk of heart-related
death.

Safety and your rehab team

After having a heart attack or surgery or
discovering you have heart disease, you may be afraid to exercise or be active.
You may worry that exercise will cause another heart attack or that you aren't
strong enough for a cardiac rehab program.

It may ease your fears to know that
as you begin your rehab, your doctor will monitor your activity closely and
health professionals will be on hand to deal with any problems you may have.
Your rehab team will tailor all of your exercises specifically for you, based
on your medical condition and overall health. All cardiac rehab begins slowly
at a comfortable pace and may be as gentle as walking on a treadmill.

If you are worried or afraid to be active again, talk to your doctor.
Exercise and activity can greatly improve the quality of your life.

Tell your doctor
and other health professionals on your rehab team about all of the medicines
you are taking, especially if they cause any side effects during
exercise. Medicines may also affect
your ability to participate in cardiac rehab. Some
prescribed medicines can change your heart rate, blood pressure, and overall
ability to exercise.

Watch for symptoms

When you
exercise, be sure that you are aware of signs and symptoms that mean
that you should stop exercising and contact your doctor.

Your ability to identify how your body is responding to
exercise and what physical conditions are normal is necessary for your
rehabilitation. It is important that you monitor specific physical information
to be aware not only of your improvement but also of possible complications. If
you have any other physical or medical concerns such as the flu,
backache, or knee pain, it is best that you put off exercising until the
problem passes. You should seek medical advice if it does not.

Check your weight

Your doctor may ask you to weigh yourself regularly, maybe every day. This helps you watch for sudden weight gain, which could be a sign of a problem.

Call your doctor if you notice a sudden weight gain. Your doctor
may tell you how much weight to watch for. But in general, call your doctor if
you gain 3 lb (1.4 kg) or more
in 2 to 3 days.

Weigh yourself on the same scale with the same amount of clothing at the same time of day. The
best time may be soon after you get up in the morning, but after you go to the
bathroom. This way, your measurements are consistent and accurate. You may want
to keep a diary of your weight.

If you have heart failure or have just had open-heart surgery,
monitoring your weight is especially important. People who have heart failure must
watch for a sudden weight gain, which points to fluid retention and heart failure that is getting worse. People who have had open-heart surgery must also watch for
sudden weight gain/fluid retention that could mean a complication of the
surgery.

Decreased severity of
angina and decreased need for medicines to control
angina.

Reduced need for hospital stays because of heart problems.
Costs for doctor visits and hospital stays are reduced for those who
participate in cardiac rehab. Visits to the emergency room are also
reduced.

Decreased blood pressure.

Reduced shortness of
breath and less fatigue in people with
heart failure.

Cardiac rehab can increase the quality of your life by
improving your health overall; helping you lose weight, if you need to; reducing
depression, stress, and anxiety; and helping to increase your
self-esteem.

What to Expect

The goal of
cardiac rehabilitation (rehab) is to help you reestablish and maintain
a healthy, active lifestyle after a major heart problem, such as a heart attack
or heart surgery, or if you have a long-term heart condition. Rehab can help you return to
work, resume recreational and other activities, and resume a normal sex
life.

To keep getting the benefits of cardiac rehab, you will have to
continue to exercise and follow the healthy lifestyle changes you've learned.

Exercise and lifestyle changes. Although exercise is a significant part of cardiac rehab, lifestyle
changes combined with exercise may be more important than exercise alone in
keeping your heart healthy. Staying with your program can give you the support
you need to make these changes a permanent part of your life and may help
reduce the risk of further serious heart problems.

Getting back to work. After you have a heart problem (such as a heart attack or
heart surgery), cardiac rehab can help you return to work safely. How quickly you
can return to work depends on how bad your heart problem is and how much
physical activity your job requires. Your rehab program might include job or vocational counseling.

Resuming sex. You or your
partner may be worried that you will have symptoms such as chest pain or will
not have enough energy for sex. Sharing your concerns and fears about having
sex is important for both partners. Both partners need to feel ready to restart
having sex. Ask your doctor or a member of your rehab team when it's safe for you to have sex.

Managing stress. Stress management
may lower the risk of serious heart problems, such as heart attacks. People who
do not deal well with anger and frustration may have a higher risk of
coronary artery disease. Learning to manage stress is
often part of programs to help you make positive changes in your
lifestyle.

Seeking treatment for depression.Depression is often overlooked, especially in older
adults, but commonly occurs after a serious heart problem. Depression can make
it difficult for you to have the energy to perform some of the cardiac rehab
programs. If you feel you suffer from symptoms of depression, make sure you
seek help.

Other Places To Get Help

Organizations

American Heart Association (AHA)

7272 Greenville Avenue

Dallas, TX 75231

Phone:

1-800-AHA-USA1 (1-800-242-8721)

Web Address:

www.heart.org

Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.

HeartHub for Patients

Web Address:

www.hearthub.org

HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.

HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.

National Heart, Lung, and Blood Institute
(NHLBI)

P.O. Box 30105

Bethesda, MD 20824-0105

Phone:

(301) 592-8573

Fax:

(240) 629-3246

TDD:

(240) 629-3255

Email:

nhlbiinfo@nhlbi.nih.gov

Web Address:

www.nhlbi.nih.gov

The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:

Related Information

References

Citations

Thompson PD, et al. (2007). Exercise and acute cardiovascular events. Placing the risks into perspective. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 115(17): 2358–2368.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Thomas RJ, et al. (2010). AACVPR/ACCF/AHA 2010 Update: Performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. Journal of the American College of Cardiology. Published online August 31, 2010 (doi:10.1016/j.jacc.2010.06.006).

Williams MA, et al. (2007). Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation, 116(5): 572–584.

Thompson PD, et al. (2007). Exercise and acute cardiovascular events. Placing the risks into perspective. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 115(17): 2358–2368.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.